May 5, 2011
Ina May Gaskin has written a piece in the Daily Beast in honor of the International Day of the Midwife. She discusses the current U.S. maternity health crisis:
Ask your average American what a midwife is, and he’ll probably look at you with a puzzled stare. Midwife? Isn’t that a kind of witch doctor, discarded by society with the dawn of modern medicine? Do midwives still exist today?
They do, of course—and I am living proof. Midwives have attended women in pregnancy and childbirth for thousands of years, across cultures. Yet midwives are far too rare in this country, particularly compared to nearly every other country in the world. The fact that they seem outmoded here illustrates a deeper problem: Not only is the profession of midwifery at risk of dying out, but the very process of giving birth the way nature intended seems on the brink of extinction. These are just a few of the disturbing trends women will be fighting when they take to the streets today, in honor of the International Day of the Midwife.
In the U.S., one in three babies is now born surgically, despite the World Health Organization’s recommendation that rates not exceed ten percent in hospitals serving the general population, or 15 percent in hospitals serving high-risk cases. When C-section rates are too low, women and babies will pay with their lives—but the same result occurs when C-section rates climb too high. This is a lesson we have yet to learn in the U.S.
According to the Centers for Disease Control, a woman giving birth today is more than twice as likely to die in childbirth as her mother was. The recent leading cause of maternal death in New York was pulmonary embolism, a complication whose incidence rises significantly after C-section. Equally concerning, far more babies than ever are born after a host of technological interventions such as induction and the use of pitocin to speed up labor, which bring along their own risks. Statistics like these compelled Amnesty International to publish a damning report in 2010 titled Deadly Delivery: The Maternal Health Care Crisis in the USA, which outlined various failures in the way our health care system treats pregnancy and birth.
How has it come to this? A century ago, when the specialty of obstetrics was in its infancy in the U.S., its founders decided that they could only succeed in promoting their profession by demonizing midwifery. Using racist and anti-immigrant slogans and caricatures, they organized a campaign to make midwifery illegal in every state possible and to frighten women away from choosing midwives by portraying them as dirty, ignorant, and evil.
As a result, when birth moved into hospitals, there were no midwives around to counter the tendency for ignorant, frightened young doctors to try to hurry a birth that would have proceeded without problems if they had just allowed a laboring mother to relax or to assume a more effective position. Only in the U.S. did obstetricians become convinced that birth was so potentially dangerous to mother and baby that they could accept the doctrine that two-thirds of all babies should be pulled out of their mothers with forceps—our forceps rate in the mid-Sixties, when I gave birth the first time. Because midwives remained an integral part of maternity care staff in every other wealthy country, obstetrics in those countries never took on the fear of natural processes that has afflicted maternity care here in the U.S. for the last century.
At medical schools around the country, the time-tested skills that are central in the education of midwives are no longer valued. In November 2007, in Cape Fear, North Carolina, a news report from a local television station caught my attention: a woman was subjected to a C-section during which the obstetrician, who cut into her abdomen, discovered that she wasn’t even pregnant. According to that obstetrician, “several doctors had examined and attempted to induce labor on the patient for several days before the C-section incident.” Not one of them seems to have manually checked the accuracy of the diagnosis of pregnancy; the intern who looked at the woman’s ultrasound and found no heart beat had assumed that “the baby” had died—failing to take into account that sometimes there is no baby inside a woman who thinks she’s pregnant and has some superficial signs of pregnancy.
Electronic discussion of this bizarre group mistake guessed that the intern who “diagnosed” the pregnancy had probably mistaken retained fecal material for a baby. I found that comment amusing, since I’ve never once felt an accumulation of poop in the shape of a baby. However, I have diagnosed two false pregnancies, one of them during my first few months of caring for pregnant women. Hands are still useful—even in the era of ultrasound.
With this radical shift, more and more doctors and nurses finish their training without ever observing an undisturbed vaginal birth—a situation that tends to send C-section rates even higher. And one that could be improved if more hospitals relied on midwives to balance medical leaders’ tendency to treat every labor as a disaster about to happen.
Read the rest of the article here.